It’s normal to lose interest in sex at times after diagnosis and during treatment. Breast cancer treatments or the cancer itself can cause fatigue, discomfort, pain and other side effects that impact your sexual desire and activity. These side effects can happen during treatment, or months or years afterward.

There are many common breast cancer treatments and side effects that can impact your sexuality.

Surgery

Mastectomy and lumpectomy, surgeries that remove all or part of the breast, can alter your body image. They may make you feel less attractive or change how your body feels to you and your partner. Some physical changes may also keep you from or lessen your interest in sexual activity:

Pain. Breast cancer surgery can lead to chest wall pain. You might feel burning and constricting sensations or a lancing-type pain, or a loss of feeling in the area you had surgery

Loss of or change in sensation of the breast or nipples from breast surgery or reconstruction. This may concern you if you enjoy breast play or have orgasms when your breasts, nipples or areolae (the area around the nipple) are touched

The onset of menopause, which brings on hot flashes and vaginal dryness, because you had your ovaries removed

Lymphedema is swelling in the arm due to removing lymph nodes as part of cancer treatment. Lymphedema can cause discomfort and affect your body image

Scar tissue or cordingthat may concern you or cause discomfort. Axillary web syndrome, also known as cording, is a possible side effect of lymph node removal. The term comes from the ropelike structures under the skin of the inner arm that develop near the site of scarring and may extend down the inner arm to inside the elbow. The cords tend to be painful and tight, making it difficult to lift your arm higher than the shoulder or fully extend the elbow

Radiation

Radiation therapy directs high-energy x-rays at precise areas to kill cancer cells. Breast radiation does not directly decrease sexual arousal or response, but it can cause side effects that may impact your sexuality, including:

Breast discomfort, due to tenderness and swelling

Fatigue

Range of motion problems because of scarring or lymphedema

Skin changes, such as redness, more or less sensitivity and thickening of the breast tissue or skin. If you enjoy breast play or have orgasms from touching your breasts, nipples or areolae, skin changes may be of special concern. Also, skin changes can make breast reconstruction more difficult and less natural looking

Chemotherapy

Chemotherapy travels through the bloodstream to kill cancer cells that are growing or dividing quickly. Although very effective at killing cancer cells, chemotherapy also affects all quickly dividing cells, even healthy ones. These include some cells that help make sex comfortable.

Sometimes chemotherapy irritates the tissues lining the vulva (the area outside the vagina) and the vagina itself, making it dry and inflamed. Irritation can spark flare-ups of genital herpes or genital warts if you had them in the past. Other side effects from chemotherapy may include:

Trouble achieving arousal and lubrication or reaching orgasm

Lack of energy for sexual activity because of upset stomach, nausea, vomiting, fatigue or weakness

Low libido, or sexual desire

Pain during penetration, when the penis, a sex toy or finger is inserted into the vagina. Touching the vulva may cause pain

Menopausal changes, such as hot flashes and irregular or no menstrual periods. As the lining of the vagina thins, you may have light spotting after penetration

Targeted Therapy

Targeted therapies are medicines that target changes in specific proteins or markers on or within cancer cells that help the cells to grow. Instead of killing all fast-growing cells, these medicines target just the cancer cells.

These medicines often have fewer side effects than chemotherapy, but they are usually given with chemotherapy. If you receive both treatments, you could have the same common side effects as you would with chemotherapy alone, such as hair loss, nausea, fatigue and loss of sexual desire.

Hormonal Therapy

Hormonal therapy starves the cancer of the hormones it needs to grow. It’s used to treat hormone receptor-positive breast cancers.

Hormonal therapy can increase menopausal symptoms and impact your sexual health. Side effects include hot flashes, night sweats, insomnia, irritability, less sex drive, less lubrication and pain during penetration. It can interrupt your menstrual cycle, if you are premenopausal. Hormonal therapy can also cause dryness and vaginal atrophy, thinning of the walls of the vagina.

Other Medicines

Some antidepressants, called selective serotonin reuptake inhibitors (SSRIs), can dampen sexual desire and affect your ability to reach orgasm. SSRIs are also sometimes prescribed to help with hot flashes.

Most women with breast cancer don’t experience clinical depression, but if you are among the 25 percent who do, treating it is important. If antidepressants are part of your treatment and they add to your sexual concerns, talk with your doctor about possibly switching to another medicine.

Antiemetics, medicines used to control or stop nausea during chemotherapy, have side effects that may interfere with sexual desire. These include drowsiness, diarrhea, constipation, headache and fever. Other medicines used during treatment can affect your sexual interest by making you feel tired or by causing bone pain.

To learn more about how to manage sexual side effects, visit our section on Sex and Intimacy.

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